HSV IS Definitively a Sexually Transmitted Infection
Herpes Simplex Virus (HSV) is unequivocally classified as a sexually transmitted infection (STI), with HSV being the most common cause of sexually acquired genital ulceration worldwide. 1
Evidence-Based Classification
HSV is explicitly categorized among sexually transmitted infections in clinical guidelines and diagnostic protocols:
- HSV is listed alongside other STI causative agents such as Treponema pallidum and Haemophilus ducreyi in differential diagnosis of genital ulceration 1
- Guidelines specifically recommend testing for genital herpes when "being examined for other sexually transmitted infections" and for sex workers 1
- HSV-2 is almost exclusively sexually transmitted, with antibodies rarely found before the onset of sexual activity 2
- Genital herpes is recognized as "an important sexually transmitted disease that is becoming more common" 3
Transmission Characteristics That Define It as an STI
Both HSV-1 and HSV-2 are transmitted through sexual contact, though their epidemiology differs:
- HSV-2: Nearly exclusively causes genital disease and is almost always sexually transmitted 4
- HSV-1: Increasingly causes genital herpes through oro-genital sexual practices, with changing sexual behaviors directly transmitting HSV-1 from oral sites to genital mucosa 4, 5
- Genital herpes is frequently transmitted in the absence of symptoms through asymptomatic viral shedding, making it a particularly concerning STI 6, 7
Clinical Management as an STI
Treatment guidelines explicitly address HSV as a sexually transmitted disease:
- FDA-approved drug labels for valacyclovir and famciclovir state: "Because genital herpes is a sexually transmitted disease, patients should avoid contact with lesions or intercourse when lesions and/or symptoms are present to avoid infecting partners" 6, 7
- Patients should be counseled to use safer sex practices in combination with suppressive therapy 6
- Sex partners of infected persons should be advised that they might be infected even if they have no symptoms 6
Common Pitfall to Avoid
Do not confuse the route of acquisition with STI classification: While HSV-1 can be acquired through non-sexual contact (causing oral herpes), when it causes genital infection, it is transmitted sexually through oro-genital contact and is therefore classified as an STI 4, 5. The stigma associated with HSV-2 may be greater because it is almost exclusively sexually transmitted, but both types causing genital infection are STIs 4.